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General NPI Number Information
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NPI Number | 1457452476
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Entity Type | Individual
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Provider Name | JOHN J MYTYCH D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 2120 W IRONWOOD CENTER DR
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2639
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Country | US
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Telephone | 208-625-6944
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Fax | 208-625-6945
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Provider Business Mailing Address
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Address Line | 280 S MAIN ST
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City | BOUNTIFUL
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State | UT
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Zip | 84010-6236
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Country | US
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Telephone | 801-505-0821
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Fax | 801-505-0803
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 10140276-0501
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 3271756
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016005082
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License Number State | IL
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